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Jerry B.
What a Relief, NOT PREGNANT!!!!
Apr 14, 2009
What a Relief, NOT PREGNANT!!!!
I found out two things this morning when I had an ultrasonic scan of my gall bladder.
First, thank goodness, I’M NOT PREGNANT. I was worried about that, RIGHT….
Second, my gall bladder still has the one large solid gall stone that takes up about 90% of my gall bladder. It hasn’t shrunk over the last ten or so years since we discovered it. But since I’ve lost these 32 pounds since starting on the pre-surgery trail, I’ve noticed a dull pain and sensitivities in the area at times. I’m still hoping to be able to have it removed at the same time I get my hernia repaired and Lap-Band put in. If it will wait that long.
I’m still awaiting my insurance company’s denial of my Lap-Band LOMN. It is the second LOMN sent to them because my weight loss center screwed up the first one by requesting a RNY By Pass, which I don’t want. They denied it also. But in order to appeal my denial I have to have been denied the surgery I wanted, not one I didn’t want. Does that make any sense? Anyhow, I’m still waiting, patiently, patiently, OH, SO PATIENTLY WAITING…
Blue Funk and NSV's
Apr 12, 2009
First off, Happy Easter Sunday to All.
I’ve been in somewhat of a blue funk the last few days as I wait for my insurance company to deny my Lap-Band surgery again. Well actually to turn down my Lap-Band surgery the first time because my weight loss center screwed up badly by requesting an RNY in the first LOMN. I have to wait and let them deny the Lap-Band LOMN to have something to challenge in an appeal. Hence forth; Blue Funk!!!!
But on the other side of the coin I’ve got a couple of NSV’s the last few days that have made me smile. The first one was from a neighbor that I haven’t seen much of over the winter. I was out in my driveway doing something a couple of days ago when she yelled from her back yard; “Hey Jerry, you loosing weight?” I said, “Yes, thank you, and I told her I’ve lost around 30 to 32 pounds. That was nice to hear.
But the second NSV is a self realization. Since starting on this journey last October I have been taking my pocket knife and cutting holes in my four leather belts I wear as I needed to. That way is not a good way to cut holes in leather, so I went to my local hardware store and found a neat hand held hole punch for leather that really makes a nice perfectly round hole in my belts. I went back and straightened out the two holes in each belt I had cut in all four of my belts. Then punched a new whole in each one because they were all were too big again, a total of three holes in each belt.
As I dressed in my Sunday go to meetin’ duds this morning I thought to myself, "Wow, that is really a neat NSV". I’m going to wear all four of those belts until I loose all my weight. I don’t care if they wrap around me twice. But, I’m going to have to buy some new Sunday go to meetin’ duds as they are starting to fall off my butt. I already bought some new smaller jeans but no good stuff, yet. So the blue funk is not as blue as before, now if I could just do something about waiting for the insurance company to deny the LOMN.
More, More Delays !!!
Apr 07, 2009
More , More Delays
Oh Yea, one screw up after another. This is becoming a true comedy of errors. First off, when I went over to my weight loss center yesterday to discuss what was needed by the lawyers for the appeal, the lady in charge of LOMN generation and appeals and I didn’t exactly hit it off very well, which of course, pi**ed me off. After some rather blunt discussion she came around somewhat, and did what I needed her to do for the appeal. She did contact the Lap-Band appeals group and my insurance so they faxed her the required forms. (I think I know why she and I didn’t hit off so good, continue on……)
Last night, after I got home, I finally got my copy of the denial from my insurance in the mail and guess what? My weight loss center screwed up big time by requesting the Roux-en-Y Gastric Bypass Procedure instead of the Lap-Band. They/she got me and another patient mixed up. I wonder what the other LOMN looked like? Anyhow, my denial was based on the RNY and not the Lap-Band, so my appeal is null and void.
Off to the weight loss center I went this morning, mad as he**. When I walked in and requested seeing her in her office, she started to get offensive. I told her to stop and listen carefully to what I had to say and I showed her what they/she had done. She ran straight for her files and pulled out her copy of the LOMN and immediately turned green. She realized how bad they/she screwed up. She then attempted to cover her butt by saying that it was no a big deal because it was denied on length of program.
I then very carefully explained to her that my appeal of the denial was invalid because I couldn't appeal through Allergan (maker of the Lap-Band) because she requested the RNY. My appeal was baseless. She turned green again and said, "I see what you are saying, I understand". She then changed her entire demeanor and became my best friend...... She immediately retyped the LOMN and was going to send off the corrected version to my insurance today.
She asked me to fill out all my parts of the Allergan appeal while I was there so that it is ready to send off the minute the new LOMN is rejected, which it will be because of their 12 month policy. She really is my best friend now, can't do enough to please me, interestingly enough.
Since my insurance now knows I will appeal the denial as soon as it is given, I wonder if they just might grant it instead having to defend their position with lawyers. ----- Nice thought, but probably not.
It’s been an interesting few days. I’m glad I know, at least, the surgeons and hospital facilities are the best around with an excellent reputation. If I didn’t already know that, then I would be looking for a new place to have my weight loss surgery. It’s frustrating to say the least, but I will prevail!!!!
Jerry
GOING TO APPEAL
Apr 03, 2009
I thought about the denial by BCBS Of Utah all evening last night and just before I went to bed I filled one of Obesitylaw.com's appeal request forms and emailed the information to Obesitylaw.com.
When I got up this morning and turned on my computer I already had a reply with some specific instructions for starting the process. Yes, I will be appealing it through them. The process has started.
Thanks to all suggesting I do this, it is the right thing to do.
ANOTHER DELAY!!!!!
Apr 02, 2009
Well now, another delay. I just talked to the weight loss center and my surgery has been denied by BCBS of Utah. When I started this Journey last October (2008) I had a six month pre-surgery program under the insurance carrier we had at the time. On January first of this year my carrier changed to BCBS of Utah and they have a twelve month pre-surgery program and will not budge from in, at least yet. Denied, have to finish the 12 month program. Said it didn’t matter what it was before, its twelve months now.
So, more decisions to make;
1. Continue on and finish the 12 month period, even though I’ve completed all the other requirements.
2. Get my gall bladder removed while I’m waiting, since it will need to be removed anyway. Then I won’t have to argue with them or the surgeons about doing three things at one time, gall bladder, hernia and Lap-Band.
3. Or, do as I would normally do; bow my back, bitch, scream and appeal it.
4. Pay for it out of pocket. (or be patient and refer to item #1 above)
DECISIONS, DECISIONS, DECISIONS. HAVE TO THINK ABOUT IT A LITTLE.
ANOTHER STEP CLOSER.
Apr 01, 2009
I got a phone call a little while ago from the Heart Group where I did my nuclear stress test yesterday. I jokingly had said earlier that I would qualify for the Lap-Band surgery if they couldn’t trigger a heart attack with the stress test. Little did I know how true that statement was…… They tried to kill me!!!
But seriously folks, they told me that my heart was normal and strong and I can only assume the only thing abnormal about by EKG last week at DWLS was the distracted tech administering it (see post from last week). As far as my normal bleep in my EKG’s they said all was fine and my heart was strong.
So, my psych exams say I crazy enough to do this, they couldn’t induce a heart attack with the stress test, and my LOMN is currently under consideration. Maybe all the pieces are falling into place and I will be able to become the real loser I know I can be soon.
Time Clock Running, For Real Now!!
Mar 26, 2009
The doctor wants the nuclear treadmill test because of the abnormality in the EKG. I guess, if they can’t induce a heart attack with the stress test than I should live through the surgery (actually, that’s my take on it). Really, I’m glad he is requiring the nuclear stress test. Being thorough is not a negative in my thinking. I do the stress test next Tuesday. At least, it didn’t delay my LOMN being sent off. YEAH, A SMALL VICTORY. Now for certain, the clock is ticking, tick tock, tick tock, tick tock……..
This has not been a good week, I spent all day both Monday and Tuesday outside with my gas powered high pressure washer cleaning the outside of my house. Temperature was 70 to 75 degrees and beautiful and I stayed wet both days. Felt good outside and it’s one of my spring time chores that I need to get finished before my surgery, the other main one is opening and painting my pool. Thought it was a good time to get started.
Apparently not, yesterday and today I got a scratchy throat, slight cough, low level temp and congestion. HELLO ZICAM. Sometimes, we just get older, not smarter!!!
A LITTLE BUMP IN THE ROAD!!!!
Mar 24, 2009
I was called today by the weight loss center and told that my EKG from last week came back abnormal. DA!!. I told them it would, they always do because I have had a little abnormal bleep in my heart beat my entire life. Other then the little bleep I've always been healthy as a horse.
Besides, that EKG was the weirdest I've ever taken. First off, the girl running the EKG machine wasn't the first bit interested in what she was doing. I would think that cell phones and texting would not be permitted during working hours, unless they are on break. Guess not.
Also the entire EKG did not take over one to two seconds. It took about five or six minutes to put the electrodes on but only a maximum of two seconds to do the test, and one of the electrodes fell off at that. WHAT'S WITH THAT? TWO SECONDS? As soon as the two second test was over, out the door the tech went looking over her shoulder she told me to "shut the door as I left"....
Anyway, I now have to have a four to six hour nuclear treadmill test next week. BULL CRAP. This will delay everything a couple more weeks, at least. Bummer!!!! I will continue on, just needed to vent a Little....
TYPE TWO DIABETIC - CAUTION!!!
Mar 19, 2009
I’ve already posted this on three of the OH forums, Lap-Band, Kentucky, and Indiana, so some of you may see this message more than once.
I am type 2 diabetic and have been for about eight years or so. Since I started these six months of dieting and exercising to qualify for my Lap-Band, I have watched my sugar levels daily. Since I’ve lost 25 or 26 pounds in the process and increased my daily exercise regiment I’ve noticed that my blood sugar levels when testing have been getting lower and lower.
I should say that for years I’ve taken three 2.5/500MG Glucovance tablets a day, 1½ every morning and 1½ every evening. That has artificially controlled by sugar levels for years. My blood levels the last few days have been in the low 90’s verses the usual 115- 118 range. So, I’ve dropped the ½ tablet off the morning dose. Except, I forget to remove it from my pill box yesterday and forgot to take my morning pills until close to 12 noon today, then I took the full 1½ tablet dose. To complicate matters more I didn’t check my blood sugar level this morning, don’t know why, just didn’t.
SO, this afternoon I went to our local WMCA to walk my normal 4 to 5 miles around the track. I was about a mile and a half into my walk when I was joined by my wife, who is our church’s secretary, and left her office to come walk with me. It’s a good thing she did. Because my wife is skinny by nature and a chocoholic, she saved me today. Let me explain.
Right after she joined me, my blood sugar level crashed. Anybody that is diabetic knows what it feels like. First you break out in a cold sweat, get light headed, and feel numb all over. If at this point if you don’t stop what you are doing immediately and introduce some sugar substance into your system, you will pass out. It hits fast and hard, without warning. I sat down very light headed and she went out to her car where she keeps her chocolate stash in her purse. She brought me a Hershey’s Chocolate bar and I ate about two ounces of it. Within ten minutes I regained my stability, got in my car and drove home to recoup. It drained all of my energy.
The reason I’m posting this is to warn anybody going through the weight loss pre-surgery phase to NOT loose track of their blood sugar levels and to test your blood as you are supposed to. PLUS, take you diabetic meds when you are suppose to and know when to change med levels (reduce) when you need to.
I know that after I have my Lap-Band put in there is a good chance I’ll be able to drastically reduce or even get totally off my type two meds, but watch your levels as your body changes going down this weight reduction road. That’s the first chocolate I’ve eaten in a while and I must say, “IT NEVER TASTED BETTER!”.
The Journey Continues .......
Mar 17, 2009
The journey continues…
I had my sixth appointment at the weight loss center this morning. I now weigh 25 pounds less then when I started this journey to wls last October (2008). I started out at 303.5 lbs then, 278 pounds today.
Dr Koehler told me the physc evaluation said I was crazy enough to do this. Actually he said it said I was an excellent candidate for wls and all was now in order.
I’ve completed my required nutrition classes, support group meetings, meetings with my nutritionist and monthly doctor’s meetings. He wrote out orders for my blood work, chest x-ray and electrocardiogram, which I did before coming home because I went there before breakfast this morning.
Dr. Koehler said that the letter of medical necessity (lomn) should be ready to fax to the insurance company tomorrow (Wednesday) or no later than Thursday. On the average he said it takes about two weeks, but could take as many as five or six weeks, to get an answer. He and I discussed the change in insurance carriers that occurred the first day of January. The old carrier had a six month pre-surgery program; the new one has a one year pre-surgery program with exceptions for co-morbidity's. I was half way through the six month program when the switch of insurance carriers happened and I have the co-morbidity's that fit the criteria of the new carrier. So, what can they say, “NO”? If so, OK then, we will wait the rest of the time period until this fall. I can be patient, I can be, but prefer not to be.
If the insurance OK’s the surgery the target dates will be the middle to end of May for my Lap-Band installation.
NOW THE WAITING GAME BEGINS ---- tick tock, tick tock, tick tock………..